POS0368 PERSISTENT PREMATURE MORTALITY IN GOUT: NATIONWIDE PROSPECTIVE COHORT STUDY
Authors: N. Mccormick, C. Yokose, K. Lin, L. Lu, A. Joshi, H. Choi
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> A recent UK study reported a higher cardiovascular event risk after gout flare episodes,<sup>[1]</sup> which may translate to premature mortality for gout patients over the long term. Prior studies reported premature mortality in gout, but did not compare demographic subgroups, and it is unknown whether the excess risk has improved over recent years at a national level. <h3>Objectives</h3> We prospectively evaluated the association between gout and the risk of all-cause and cardiovascular mortality in the latest US general population data and compared with the prior data. <h3>Methods</h3> Using nationally representative samples of US adults in the National Health and Nutrition Examination Survey (NHANES), linked prospectively with vital statistics data, we examined the association between gout and mortality and compared Early (NHANES III: 1988-1994) and Late cohorts (2007-2016), as well as key demographic subgroups defined by age, sex, and self-reported race/ethnicity (Black vs. White). Hazard ratios (HRs) were calculated over 10 years adjusting for atherosclerotic cardiovascular disease (ASCVD) risk factors, cardiometabolic comorbidities, kidney function, and relevant medications. <h3>Results</h3> Adjusted HR for all-cause mortality comparing US adults with and without gout in aggregate was 1.19 (95% CI, 1.08‒1.32), with the same HR in the Early and Late cohorts (1.19; 1.02‒1.38 and 1.19, 1.03‒1.37, respectively) (<b>Figure 1</b>). HR was larger among those &lt; 60 years (1.62; 95% CI, 1.19‒2.19; p-interaction &lt; 0.001 vs. age <b>&gt;=</b> 60 years) and among women (1.33; 95% CI, 1.11‒1.60, p-interaction=0.03 vs. men) (<b>Table 1</b>), and was also prominent among Black individuals (HR, 1.40; 95% CI, 1.12‒1.74). Corresponding HR for cardiovascular mortality in the late cohort was 1.39 (95% CI, 1.09‒1.78). All associations remained similar when adjusting for serum urate levels. <h3>Conclusion</h3> This representative cohort study illustrates premature mortality in gout at a national level, even after accounting for serum urate levels, which has not improved over past decades. Excess mortality was higher among women and younger adults, and was more prominent among Black individuals; the latter group already experiences an excess <i>prevalence</i> of gout at the US national level, compared to White individuals (age- and sex-adjusted odds ratio for gout=1.5 (1.2 to 1.7)).<sup>[2]</sup> These data are suggestive of continued shortcomings in current gout care practices and a compelling need to understand and mitigate the premature mortality risk in gout, especially for women and Black individuals. <h3>References</h3> [1]Cipolletta E, Tata LJ, Nakafero G, Avery AJ, Mamas MA, Abhishek A. Association Between Gout Flare and Subsequent Cardiovascular Events Among Patients With Gout. JAMA. 2022;328(5):440-50. [2]McCormick N, Lu N, Yokose C, et al. Racial and Sex Disparities in Gout in US Adults. JAMA Network Open. 2022;5(8):e2226804. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Natalie McCormick: None declared, Chio Yokose: None declared, Kehuan Lin: None declared, Leo Lu: None declared, Amit Joshi Employee of: Regeneron, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart, Grant/research support from: Ironwood and Horizon.